68-1037 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: Is .AP I T FOR SANITATION PERMIT --------------------------------- -'. i` (Complete in Triplicate) Permit No. _��_ .:7 ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _`y_. � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �_ �_____,__?____ __________ �`' ' - -�--- --- ��LrZ�p'1----------------------�--�-�Gr'-'�''� - -�rj-- ��"` `ISUS TRACT -------------- ----------- Owner's Name ? = /'t------------------ -------------------------------------------------------_---------------------Phone ---------------------------------- Address ________ _ City Y ------------------------------- --------------------------__---------------- Contractor's Name 'Z&41--a r-5---------------------------------------------- --------------------------------------------------------License # /7-7,g�3--- Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:-----I----- Number of bedrooms ._(--------Garbage Grinder' _____ Lot Size --------------------------- Water Supply: Public System and name ----------- - - - Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam P- -'-Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type_________________-_______ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) R NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i 1 tb PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size -_9AS- ____s9_yX _�_x_ - -_,____ Liquid Depth ____�_____________------ 7 Capacity/ TypeMaterial------ o. Compartments . ................ N Distance to nearest: Well ____----------------------------Foundation _____________ Prop.Line _�................. LEACHING LINE [ ] No. of Lines __/__________________ Length of each line---8_0__~-------------- Total Length ,_tQ"o._................. 'D' Box --vo Type Filter Material )�I_C-lf--------Depth Filter Material __r$�__P.-__..__......................_... Distance to nearest: Well _______________________ Foundation _______________________ Property Line ------------ ........... SEEPAGE PIT [ ) Depth _____ Diameter ______________ Number ---------------------------- Rock Filled Yes '❑ No 0 �O Water Table Depth ------------------------------------------ -----Rock Size -------------------------•-- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------ ---------------------------------------------- ------------•-•-------------- Disposal Field (Specify Requirements) ___-_____-__ ______________ --------------- ---------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become Iect to Workman's Compensation laws of California." Signed -- 6 - ------------------------------- Owner By - Title (. --r---------------- ------ ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- Z _VV----------------------------------------- ------------------------ DATE _fZ-- G - BUILDING PERMIT ISSUED _ __________DATE _____________ ----------------------------- ADDITIONALCOMMENTS --------------------------------------------------------- ------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- - - - ---------------- - - - - Final Inspection by - -' Date ---f2 r j(;---------------------- SAN JOAQUIN LOCAL HEALTHY TRICT E. H. 9 1-'68 Rev. 5M